Art has the capacity to change the self-orientation of both the artist and the viewer. In producing art, the artist interacts with his or her internalized objects. The creative act can thus become a therapeutic tool, extending from verbal experiences into nonverbal and pre-verbal experiences across all stages of psychological development. Significantly, art allows for critical distance, retrospection, and vast opportunities for individual choice and, thus, may be conducive to an improved self-image and self-esteem. Dr Janos Marton,1 the Director of the Living Museum, believes that the success of his innovative psychiatric rehabilitation program stems from capitalizing on the intrinsic properties of the artistic process: “The patient’s particularized, broken, fragmented self must fit into a more manageable flow. Then, the patient eases his/her way into a slow process of identity change. . . . Self-transformation is the objective of all art, and the [patient] artists . . . no less than others.”

Dynamics of art

Art perception relies on a dialogical communication between the artist, the audience, and the cultural tradition that allows for new interpretations to be made and new meanings to be generated. Inherent in all artistic activity, these dialogical mechanisms become particularly striking in outsider art and can serve as a basis for fighting stigma. All artistic creation is a bridge to the social: art can exist only among other art and must be preceded by art. “An isolated text is incapable of generating meanings; like any dynamic generating system, a text requires input of outside information, which in this case implies an interaction with other texts and cultural environments.”2 The aesthetic value of an artwork does not depend on the fulfilment of the norm. In non-artistic communication, it is not the language but its content that carries information: we do not pay attention to the shade of red used on a stop sign. While this aspect of communication remains present in art, it is not exclusive nor is it necessarily the primary one.

Although in a non-artistic communication it is precisely the adherence to the rules that ensures adequate transmittal of a message, in a work of art this proves insufficient and is often detrimental. Simple adherence to a set of rules does not create aesthetic value. “If we dealt only with a strict system of rules, each new work would represent an exact copy of a previous one, redundancy would prevail over entropy and the artwork would lose its informational value.”3 Kitsch is an example of artwork that follows well-known models closely, without contributing any original interpretation.

If mere adherence to the norm does not create artistic value, neither does the complete destruction of the norm. The long-standing popular misconception of outsider art as free from existing conventions, social or aesthetic, has been easily challenged in an age when access to the internet is widespread and long-term institutional isolation of patients is rare; more important, this contradicts the nature of the artwork as a semiotic structure. Indeed, art without any rules, without structural relationships is impossible. Limitless choices, absence of rules, and absolute freedom from any set limits are not the ideal but rather the death of communication.

When faced with an unknown alphabet whose rules are effectively nonexistent for us, we are unable to decipher any message at all. At the most abstract level, art represents a dynamic relationship between following an existing aesthetic norm and deviating from it. A closer analysis shows that a work of art often exists at the intersection of multiple concurrently active aesthetic norms. Any living culture depends on constant exchange between the peripheral and mainstream, archaic and innovative, high-brow and low-brow; it is this dynamic that allows art to accumulate new meaning over time.

Art production allows a maximum freedom of choice for the artist while at the same time providing a connection to existing rules, conventions, and structures. The greater the number of potential choices available to the artist, the more valuable is the information represented by a particular choice. The audience’s assumptions of the artist’s intention and accountability play a particularly big role in the interpretation of outsider art. The more the audience is aware of an existing artistic model on whose background the given artwork functions, the stronger they perceive that work’s uniqueness. The individual and the universal are no longer isolated but, on the contrary, require each other.

What new information does this article provide?

? The article focuses on the theoretical framework underpinning the contemporary understanding of the dynamics of psychiatric art. Using the semiotic approach to art production and perception, the article makes the connection between the dialogical mechanisms of art and the potential uses of art to counteract stigma, including self-stigmatization.

What are the implications for psychiatric practice?

? Creative works by patients provide a key source of information in the diagnostic process. Furthermore, because all artistic activity is a communicative act, working with patient art aids in gaining a better understanding of the preserved aspects of a patient’s personality, beyond the pathological syndromes, and in building a better rapport. Gaining insight into patient art allows for more effective planning of the specific medical and social rehabilitation strategies. At the community level, outsider art is a powerful tool in anti-stigma campaigns.

Aesthetic function arises at the intersection of a highly individual activity and the established cultural codes and structures. Any art object is saturated with values and must be analyzed in relation to its surrounding society in order to understand how it is perceived. Connecting spectators to meaning just as it connects the artists to collectors, art fosters cooperative communication in which the dignity and individuality of a mental health patient may be reaffirmed.